Table 2.

Barriers to implementing TB preventive therapy into a comprehensive TB program in a rural setting by CFIR domain and construct

Barriers	Construct
Intervention characteristics
Formal training of HCWs	Knowledge, evidence strength
Knowledge of government pharmaceutical procurement protocols and schedules	Complexity/access to knowledge and information
Lab processing time, patients have to wait overnight at hospital for results	Complexity
Outer setting
Transportation	Needs of community
Time and money to get to clinics	Needs of community
Education regarding TPT	Needs of community
Increased pill burden	Needs of community/patients
Not feeling sick, so why take medicine	Patient needs and resources
Inner setting
Majority of community HCW’s are based in clinics and not in community	Readiness for implementation
Stock outs of medication	Readiness for implementation
Concerns around regimens, toxicity, and prescribing	Readiness for implementation/access to knowledge and information
Ongoing debate/lack of consensus about IPT among healthcare providers	Readiness for implementation/relative priority
Network/connectivity not always reliable at clinics, challenging to do online trainings, upload data, etc	Readiness for implementation/available resources
Competing prioritization of TPT in clinics and hospitals	Priorities, culture
Community stigma associated with TB and HIV	Compatibility
Characteristics of individuals
Limited training of healthcare workers on clinical assessment, may contribute to missing cases	Knowledge and beliefs about the intervention
Challenging access to the community because of poor roads and infrastructure	Complexity/readiness for implementation
Communities are not taking DS-TB as seriously compared with HIV or DR-TB	Knowledge and beliefs about the intervention
Flexibility in health provider’s visit/agenda with patients	Implementation climate/relative priority
Fear of making a mistake or a misdiagnosis	Self-efficacy/knowledge of intervention